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Personality disorders in leaders: Implications of the DSM IV-TR in assessing dysfunctional organizations

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DOI (Permanent URL): 10.1108/02683940610673942

Article citation: Alan Goldman, (2006) "Personality disorders in leaders: Implications of the DSM IV-TR in assessing dysfunctional organizations", Journal of Managerial Psychology, Vol. 21 Iss: 5, pp.392 - 414
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Implications of the DSM IV-TR in assessing dysfunctional organizations
The Authors
Alan Goldman, Arizona State University, Glendale, Arizona, USA
Abstract

Purpose – The aim of this paper is to assess highly toxic leaders and dysfunctional organizations as presented via management consulting and executive coaching assignments.

Design/methodology/approach – The paper employs an action research approach via two participant observer case studies incorporating the DSM IV-TR: Diagnostic and Statistical Manual of Mental Disorders.

Findings – The paper finds that the nexus of dysfunctional organizational systems may be located in “pre-existing” leadership pathologies.

Research limitations/implications – First, additional research will be needed to confirm and extend the findings of individual pathologies in leaders to dysfunctional organizational systems; second, a closer look is necessary at the applicability of the DSM IV-TR to pathologies at the organizational level; third, due to the action research, case study approach utilized, there is somewhat limited generalizability; fourth, there are limitations re: the applicability of DSM IV-TR as an assessment tool for management researchers due to the necessity of training in clinical psychology.

Practical implications – The importance of distinguishing personality disorders in leaders from toxic behaviors falling within a range of “normal pathology,” and the ability to assess individual leadership pathology within organizational systems via the clinically trained usage of the DSM IV-TR; providing clinical assessment tools for reducing the number of misdiagnoses of leadership pathology in the workplace; encouraging collaboration between management and psychology researchers and practitioners.

Originality/value – This paper fills a gap in the toxic organizations research by identifying personality disorders in leaders and providing an action research agenda for incorporating the DSM IV-TR as a means of extending the repertoire of assessment tools;
Article Type:

Research paper
Keyword(s):

Leaders; Individual behaviour; Personality; Organizational effectiveness.
Journal:

Journal of Managerial Psychology
Volume:

21
Number:

5
Year:

2006
pp:

392-414
Copyright ©

Emerald Group Publishing Limited
ISSN:

0268-3946

Management theorists and practitioners have in recent years increasingly addressed the darker, toxic side of organizations and leadership (e.g., see Bowles, 1997; Fox and Spector, 2005; Goldman, 2005; Kellerman, 2004; Kets de Vries, 1991; Kilburg, 2000; Lawrence, 1998; Levinson, 1972; Miller, 1990; McLean, 2001). Drawing on personality research, a robust strand of investigation is emerging focused on dysfunctional leadership and organizational behavior (e.g. see Kets de Vries, 1989, 1995; Lipman-Blumen, 2005; Lowman, 2002; Lubit, 2004). Of particular interest is the incidence of personality disorders in leadership and the implications for organizations (e.g. see Maccoby, 2003).

To date, research addressing personality disorders and other pathologies in leadership has convincingly displayed the relevance of incorporating psychological and psychotherapeutic perspectives into the analysis of dysfunctional organizations. This line of inquiry has been exemplified in: psychodynamic perspectives on organizations (Hirschhorn and Barnett, 1993; Miller, 1997; Parker, 1997); organizational therapy (Matheny, 1998; Schein, 2000); cognitive OD stressing the mental processes of individual organizational members (Matheny and Beauvais, 1996; Matheny, 1998); and the psychoanalytically grounded work of Kets de Vries (1991) and Kets de Vries (1984). Unique to Kets de Vries' (1991, pp. 75-6) approach was his announcement that the clinical approach initially utilized in the one-on-one therapeutic relationship between analyst and patient has “now spread to the study of organizational practices”. As subsequently described by Goldman (2005), the ability to articulate and operationalize a clinical approach provides a basis for guiding and structuring action research in leadership pathology and dysfunctional organizations.

In this paper I incorporate the DSM IV-TR: Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000) via the presentations of two case studies that include: organizational narratives; observations of the workplace; assessments of interpersonal and organizational dysfunction; clinical diagnoses of personality disorders in leadership; descriptions of leadership and organizational interventions; and utilization of DSM IV-TR criteria for diagnoses. The case studies examine two personality disorders within their respective organizational contexts:

narcissistic personality disorder; and
antisocial personality disorder.

In assessing “pathologically flawed” patterns of leadership behavior the diagnoses call to mind a statement by Kets de Vries (1995, p. 217), that “some leaders go far beyond the abnormal ways of functioning … they go off the deep end”. Accordingly, this paper contends that the nexus of the dysfunctional organization, may primarily reside in the seriously flawed leader harboring a long-standing personality disorder.

Personality disorders and their organizational contexts point to the presence of pathologies in the workplace generally falling outside of the expertise area of leadership scholars and management consultants. The prospect of DSM assessments of organizational pathology is rather awkwardly situated in between industrial and organizational disciplinary silos of leadership, management, psychology and psychiatry. At stake is the demarcation of mental illness and psychopathology extremes in leadership not to be confused with the recent leadership studies addressing “milder” toxicity (e.g. see Frost, 2003; Lubit, 2004). This “toxicity research” is primarily focused on flawed, difficult leaders (and enabling followers and toxin handlers (e.g. see Lipman-Blumen, 2005)), and predominantly falls within the range of what Maslow (1971) termed “normal pathology” in the workplace. In the course of addressing organizational therapy and the recent surge of toxicity research into organizations and leaders, Schein (2000, p. 36) commented that “some level of toxicity is normal. That really has to be hammered home rather than thinking of toxicity as abnormal”. It is important to note that while this emergence of leadership research addressing toxicity does at times utilize the language or semantics of the DSM, there is an absence of DSM guided clinical assessments of psychopathology in either individual or organizational systems. In contrast, the clinical usage of the DSM IV-TR in this study will clarify the incidence and clinical assessment of highly toxic, pathological leaders and the implications for the study of dysfunctional organizations.
DSM IV-TR: search for objective standards of assessment

Despite a groundswell of academic, Fortune 500 and international media interest in toxic leaders and organizations, there is a notable absence of objective standards in assessing or clearly defining what constitutes extremely toxic or pathological behavior in the workplace (e.g. see Fox and Spector, 2005; Goldman, 2005). On the one hand, there is widespread agreement that there will be dire consequences unless organizations grasp and respond to toxic and psychopathological behaviors in individuals that invite danger into their companies (e.g. see Fox and Spector, 2005; Kellerman, 2004; Kets de Vries, 1991; 1995; Lipman-Blumen, 2005; Lubit, 2004). Shocking incidents of workplace terrorism (e.g. see Van Fleet and Van Fleet, in press), suicides, sabotage, executive theft and other company crises have triggered more of an inward looking, psychological awareness of organizations, leaders and employees, and the recognized need for early detection systems. Toxic behavior (e.g. “bullying” and “displays of anger and aggression in the workplace”) is under scrutiny and occupies the attention of leadership, human resources (HR), employee assistance programs, academics and consultants. There is little consistency or agreement in leadership or management consulting circles, however, concerning how assessments or diagnoses are to be made or even as to what constitutes toxic or dysfunctional behavior in either individuals or organizations. Critical is the ability to discern between more serious pathologies, such as personality disorders and the plethora of leadership researchers focusing on “flawed” or “toxic leaders” who have been mentally and emotionally impacted by divorce, child custody battles, accidents, injuries and deaths, and myriad psychosocial and environmental stressors experienced during the course of organizational life.

As has been substantiated by the DSM IV-TR's collaborative efforts of over 1,000 mental health professionals and numerous professional organizations, personality disorders are characterized by enduring, inflexible, and stable patterns of behavior. When the patterns are identified as recurring destructive behaviors, they result in significant distress or impairment in social and occupational areas of functioning – impacting the individual, significant others, colleagues, associates and subordinates in the workplace. The assessment of a personality disorder requires a differential diagnosis including but not limited to: a structured case history; clinical interviews and assessments; possible field research into social, family and organizational environments; an assessment of the client's medical, family and psychological history; and a minimum number of personality features that meet the criteria for an official diagnosis. The clinical diagnosis of a personality disorder stands in sharp contrast to the milder personality turbulence faced by leaders who may be experiencing family or occupational conflicts and generalized toxicity. Also of importance is the difference between leaders who meet several of the characteristics for a narcissistic or borderline personality disorder but fall short of the minimal criteria. This “short of psychopathology zone” may mimic some of the characteristics of a full blown personality disorder but will be: shorter lived; lack a long-term personal and occupational history; be less severe; and exhibit lower degrees of dysfunction in the individual and the system. This less severe category of flawed leadership falling short of the psychopathology zone appears to be the primary domain of the “toxicity light” and dysfunctional focus in leadership research and commentary. As a means of gaining greater insight into the broad range of leadership and workplace disturbances I propose that a study of the DSM can only enrich understanding of the difficult distinctions to be made between the leader who has anger management “issues” in contrast to a leader suffering from an antisocial personality disorder.

In studying more chronic and deeply flawed forms of leadership and organizational conflict, the DSM IV-TR is also helpful in efforts to come up with something closer to what members of the Harvard Negotiation Project have described as “objective criteria” or “independent standards” (see Fisher et al., 1991). In addition, the DSM is invaluable training in recognizing psychopathology and not treating organizational or leadership pneumonia as if it were an ordinary corporate cold.

Interest and acknowledgement of the DSM within the management discipline is not new. The leadership and management literature reveals researchers and practitioners who display awareness of the DSM (e.g., see Kets de Vries, 1991; Levinson, 1976; Lubit, 2004). References to DSM pathologies have been made in the writings of Kets de Vries and Miller (1984) when the authors transposed the semantics of abnormal psychology into the “neurotic organization.” Lubit (2004) recently provided myriad references to DSM categories of pathology in the process of describing symptoms and behaviors of toxic managers, subordinates and difficult people in the workplace. Notably absent, however, is an attempt to situate and operationalize the DSM in assessment or intervention..

What follows are two “case study” examples of applications of the DSM IV-TR to scenarios of highly toxic leadership and organizational pathology in the workplace. In both cases, I am the action researcher alternately wearing (and synthesizing) the hats of management consultant, executive coach and psychotherapist. As a consultant and participant observer, I first assess reported organizational symptoms and anecdotal evidence, conduct an organizational needs assessment and narrative interviews, and engage in extended workplace observation. Based on consistent reports of chronic interpersonal dysfunctions and “self-problems” involving company leaders, I proceed to the executive coach perspective and ultimately to wearing the psychotherapist hat - conducting structured clinical interviews as required for DSM IV-TR differential diagnoses. In the two cases described, I find personality disorders within individual leaders at the nexus of company dysfunction.

The following case studies are based on actual consultations with names and players fictionalized. Case studies are presented as a step in the direction toward conceptualizing prototypes of personality disorders in leaders within organizational systems, and in distinguishing between general toxicity and psychopathology. In the course of presenting the case studies, I interject information on the composition and usefulness of the DSM IV-TR as a tool for leadership research, management consulting and coaching. I will be addressing both those with and without specific training in clinical psychology, psychotherapy and psychiatry. In the process of conveying the case studies, I serve as an action researcher advocate for interdisciplinary collaborations in the study of leadership and personality disorders between management and psychology.
Case study I: narcissistic personality disordered leadership

Dr Gina Vangella is the chief surgeon and director of the Department of Cardiology at the Beach Harbor Heart Institute, a center for excellence known around the world. Dr Vangella is quick to talk of her “great fortune” and “brilliance” and has many admirers within Beach Harbor. In her flamboyant way, Dr Vangella always seems to demand attention and respect. The majority of her subordinates believe that Dr Vangella is “an incredible surgeon, highly intelligent and a capable leader of the department.” They will go to the ends of the earth for her. Over the past seven years, the doctor has increasingly conveyed a sense of “entitlement” to her colleagues and staff. At times, Dr Vangella seems to be very preoccupied with herself, is sparse in her communication with colleagues and, despite widespread admiration, there are a few colleagues who privately perceive her as being “arrogant and haughty.” According to one fellow surgeon and colleague:

Dr V expects that all the pieces will fit into place and that she will have an idyllic, flawless scenario when it is surgery time. But that's not the real world and she can't even begin to accept that.

Dr Vangella has oftentimes boasted of her fluency in the French language, and her passion for French Symbolist and Surrealist literature, poetry and fine art. Dr Vangella considers herself a “French Surrealist Artist.” Articles appearing in the Beach Harbor Heart Letter (the hospital newsletter) have announced exhibits of her paintings and sketches at local art galleries and her membership in the “exclusive and world renowned Post-Modernist French Surrealist Society of Artists.” Shifting from artistic to medical circles, Dr Vangella is also extremely well known for having studied in Paris with the master heart surgeon, Dr Francoise Barteau, who perfected the minimal incision mitral valve heart repair. This procedure is performed on individuals who have mitral regurgitation, where there is a back flush of blood, with the blood supply not being able to move appropriately through the heart muscle and the body. Without surgery to repair or replace the faulty mitral valve, the patient is at risk for developing an enlarged heart that eventually will fail and result in premature death.

Dr Vangella is sought out around the globe. She has been one of the most heralded and productive mitral valve surgeons in the world. As Director of Cardiology, Dr Vangella oversees a world-class assembly line of mitral valve procedures. Dr Vangella's productivity has been the talk of the town at cardiology conferences across North America, Europe and the Middle East, as she has averaged as many as five successful mitral valve surgeries per day. Her productivity has catapulted Dr Vangella and the Beach Habor Heart Institute to the top tier in cardiology. Beach Harbor is held in such high esteem that the seventh floor is referred to as the “Saudi floor” or the “black gold floor.” This is due to the large number of Saudi royalty and “oil families” who come to the institute for heart surgeries. The seventh floor is reserved for the ongoing Saudi constituency.

Dr Vangella is determined to be the best. She speaks of her surgical procedures as “flawless.” Dr Vangella is looked up to as an extraordinarily high status doctor by her patients and their families. She is what you might even describe as “worshiped.” Following successful surgeries she is oftentimes showered with expensive gifts by the patient's family. The problem among nurses, fellow surgeons, hospital staff and administrators is that Dr Vangella also expects similar adulation from all employees and colleagues.

As director of the Department of Cardiology, Dr Vangella calls monthly surgeon, nurse and staff meetings. Dr Vangella typically shows up 20 minutes to a half an hour late for these meetings. On several occasions she has walked in late talking on her cell phone, and continued the conversation while a room full of colleagues and subordinates overheard her side of the conversation.

Occasionally there were some whispers of Dr Vangella's “venomous and tragic divorce,” a battle that was staged over two years in the local municipal court. One baffled colleague spoke at one of the monthly meetings while they were all waiting for the fashionably late Dr Vangella. “How can such an elegant, refined and brilliant lady be in so many conflicts and such a nasty divorce. I guess she's just unlucky.” It was as if the hospital staff wanted to believe in Dr Vangella. They were true believers and enabling followers (e.g., see Lipman-Blumen, 2005). In the light of day there was a careful crusade to avoid any mention of toxicity.

Removed from the adoring public eye another constituency was developing. There were a number of behind-the-scenes venues buzzing with negative talk about the doctor: at watering holes; hospital parties; and team building weekends in the wilderness. Despite her alleged brilliance and extraordinary medical, surgical and artistic talents, employees began quietly talking among themselves that Dr Vangella had a “Napoleon complex” and “wants to be worshiped 366 days a year!” Agitated about a pattern of selfish, narcissistic behavior over a period of many years, a growing group of hospital nurses and heart surgeons were not up to the hero worship agenda. The protest first began in the form of a grapevine that insidiously grew over two years. They accused the loyal followers of Dr Vangella as “being in denial.” The grapevine spoke of Dr Vangella's lack of empathy and coldness toward her colleagues and staff. Colleagues stated that Dr Vangella “spent an extraordinary amount of time complimenting herself to colleagues, never stopped acting self-important, was self absorbed and rude in public, and in many instances even exaggerated her commendable accomplishments far beyond recognition.” According to one report:

Dr V was never simply satisfied with doing a good job. She had to be ignoring and emotionally abusing her colleagues while she was busy shattering surgical precedent and sending shock waves across the Atlantic.

Fellow surgeons, nurses and staff, reported that Dr Vangella became harder and harder to work with and be around. Complaints levied against Dr Vangella were further accelerated when four independent sources stressed that the doctor had been “exploitative of others in order to achieve her personal goals.”

To complicate matters, the grapevine talk and organizational gossip increasingly got back to Dr Vangella. She was privately devastated by the extreme criticism taking place in the hospital trenches. Vangella publicly blamed nearly everyone in sight for her problems. Dr Vangella could be stern, loud and extremely vocal. At times, however, she appeared to vacillate between acting superior and highly self-critical. Sometimes Vangella withdrew and confessed to Dr George, a surgeon she occasionally confided in how badly she felt about the rumor mill. George reported that Vangella stated that:

I question myself more than I want to admit to. I feel unworthy and fragile sometimes … especially when I am being so maliciously maligned.

Clearly the dark organizational underbelly was able to throw Dr Vangella into states of reflection and defensiveness. Dr George was concerned that the gossip might eventually impact Dr Vangella's performance. Dr Vangella offered to George that:

[…] if even a fraction of those ugly indictments were true I would feel as if I do not deserve my international reputation. I might even question my ability to perform surgery at a world class level.

At another point, Dr Vangella stated to Dr George that:

Dr Workman doesn't realize how much I admire his surgical technique. He accuses me of being a bitch and acting arrogant, when I feel humbled and envious of his great skill.

But to fellow doctors and staff, Dr Vangella was known as the “ice queen.” Whenever anyone would even insinuate that there was reason for questioning, doubting or criticizing Dr Vangella, she responded with what Dr Workman mockingly described as “an icy stare from the tundra North – worthy of our in house, self anointed movie star.”

Fellow doctors complained that Dr Vangella was “unbelievably sensitive to her own needs” and “incredibly insensitive to her colleagues' and staff's needs and feelings.” They reported to HR that Dr Vangella was “all about herself” and “that's not the way it should be since surgical teams are always at the edge of the cliff, performing life and death procedures.” Criticism reached a crescendo when after three failed mitral valve surgeries, the talk around the hospital cafeteria was that “Dr V. made the surgical team crazy with her type A and holier-than-thou nastiness and the team was doomed to botch up.” Questions lurked whether Dr Vangella was she also insensitive to the patients' needs?

In response, Dr Vangella further withdrew from contact with hospital doctors, staff and administrators and retreated into a world of élite French and European heart surgeons and artists. She immersed herself in her circle of artists: successful painters, ballet stars, classical musicians, actors and actresses. In the words of a fellow surgeon:

Dr V walks around with her nose in the air and thinks she's better than everyone else.

It was undeniable that Dr Vangella was traveling in élite artistic and medical circles. Yet behind closed doors, Dr George was “knocked out that she doubted herself deeply and appeared to be envious of some of the surgeons and nurses who didn't even have half of her talents and expertise. She is an enigma!”
Initial assessment/diagnosis

After years of admiration for Dr Vangella, HR was suddenly besieged by complaints and the threat of grievances. But no one dared to file a formal complaint. This was considered “too risky.” The common threadwork in the informal grievances was that Dr Vangella has this insatiable need for admiration and lacked empathy for anything other than her own accomplishments. They confirmed that Dr Vangella lived in a fantasy land of perfect love, perfect surgeries, perfect art and superior beings. She was forever admiring and brushing her very long blonde hair in the hallway mirrors. Dr Vangella used to bother her colleagues, always “fishing for compliments” and talking about how she went to “the best medical institutions” and will “only buy Gucci brief cases.” She bragged that she went to the “best hair stylist West of Paris,” and that some of her colleagues “obviously dressed themselves in Wal Mart” and “have their hair cut at the Salvation Army or Super Ghetto Cuts.”
Consultation with Dr Vangella

Catapulted by the tragedy of three failed mitral valve surgeries and the accompanying talk in the grapevine about the Napoleonic and grandiose behavior of Dr Vangella, HR decided to have a talk with the surgeon. The HR director explained that there were pending informal grievances specifically naming Dr Vangella, and that three of these grievances were a direct result of “incidents” that took place during the failed mitral valve procedures. Vangella was informed that two of the three pending grievances cited that:

Dr V went ballistic, freaky and frantic when a fellow surgeon asked for clarification on her decision making during one of the failed procedures.

An inhouse investigation revealed that Vangella screamed out several times during the surgery, “How dare you question my judgment!” According to reports, the screams sent shivers down the spines of several members of the operating team. When the surgeries failed, Vangella spewed out scathing remarks and accusations at her medical associates. It appeared as if her fragile ego could not allow for personal failure and it had to be blamed on her colleagues.

HR proceeded to spell out their response steps regarding the yet-to-be-filed grievances, carefully informing Dr Vangella of the procedures for compliance that they were following, HR also informed Dr Vangella that it was protocol for HR to request that she consider a visit with the employee assistance program. Dr Vangella declined and stated that:

I need an executive coach or management consultant who can guide me on how to deal with all of the bottom feeders, vultures, pigeons and sea gulls around this hospital.

The hospital complied and called in a management consultant.

HR and the president of Beach Harbor, Dr Marvin Calding, presented me with their own needs assessment and diagnosis. Dr Vangella was in their collective opinion an “outrageously self-centered, egotistical lady who was a fright to work under.” Both the president and HR, however, were troubled by the fact that Dr Vangella was extremely productive and until the recent failed surgeries and the groundswell of complaints, she was their “superstar.” Was she just a “difficult genius?” Calding himself stated that he was “a bit amused by Vangella's manner with him in several talks.” He continued on that “unless I was dreaming, I would have thought that Dr Vangella thought that she was the superior and I was the subordinate! I could use language to describe her attitude but I will refrain from doing so.” It was decided with HR that no needs assessment or interviews would be held with Dr Vangella's colleagues. It was my mission to assess only Dr Vangella, in the form of consultations.

Dr Vangella was visibly disturbed, indignant, defensive and arrogant at the onset of our first consultation session. Vangella's behavior was consistent with the theory of threatened egotism and aggression (Baumeister et al., 1996; Penney and Spector, 2002), predicting that “narcissistic individuals would be more likely to engage in counterproductive workplace behavior, especially in response to threat” (Spector and Fox, 2005, p. 165). Dr Vangella told me how when informed of employee complaints pending against her that she “scolded the HR manager and ridiculed her as an inferior who has no right to question her better and superior.” After a period of indignant ranting and raving, Vangella revealed that she was already taking medication prescribed by her internist for “anger and stress management issues.” Until this point this was classified data.

Once a careful case history was taken, I switched hats from high impact leadership consultant (Schaffer, 2002) to rapid cycle executive coach, to brief existential psychotherapist (e.g. see Strasser and Strasser, 1997). In the course of the early consultations I informed Dr Vangella of my broad training, preparing her that “I might have to change hats.” Equipped with a DSM IV-TR text, I showed Dr Vangella several Cluster B personality disorder diagnoses and asked if any of these applied to her. She read through the diagnoses and was quite thorough. She stated that she thought she had a few symptoms from all of the disorders and commented that “having a few symptoms is idiotically normal. Is it not?” I replied in the affirmative. I pressed to find out if there was any disorder that she felt fit her better than all the others. My “strategy” was one of respect, inclusion, collaboration, and an uprooting search for how Vangella construed her world, all basic tenets of existential psychotherapy. In response to my inquiry regarding the disorder in the DSM IV-TR that best fit, Vangella replied:

Yes. You know which one. The Narcissistic Personality Disorder. How in the world do I wind up at the knees of the top Parisian heart surgeons and artists and strive for the unreachable? Of course I'm a narcissist. I'm proud of that. And isn't it a question of to what degree, doctor? That's what drives me and makes me successful. It's why I achieve and strive for unusual levels of excellence. I've read that wildly successful leaders are oftentimes narcissists. Deny that if you can, Doctor.

The diagnosis she chose was DSM IV-TR 301.81, Narcissistic Personality Disorder. Dr Vangella was absolutely on target. Yes, narcissism is the initial driving force behind many leaders. It can be the driving engine and result in extraordinarily high levels of productivity (e.g. see Maccoby (2003) for an examination of the “productive narcissist”). But it is a question of degree. How many of the symptoms do you present? How long have the symptoms been present? Do they significantly impair your personal, social and workplace functions? I empathetically communicated to Dr Vangella that as much as the narcissism propelled her accomplishments, voracious ambition, and drive for excellence, she was not as functional when it came to interpersonal relationships in the hospital. Lurking was the very touchy point as to whether interpersonal problems stemming from narcissism had in fact entered into the operating room and diminished her abilities as a heart surgeon during any of the failed procedures. We discussed the narcissistic symptoms at length. We further discussed the role of emotions, emotional intelligence and emotional unintelligence (e.g. see Goleman, 1998). We investigated how some of her colleagues felt as if they were “targets” for her disruptive, unreasonable behavior. We explored how and why the narcissistic personality disorder diagnosis fit. It turned out that Dr Vangella had a history dating back to when she was about 11 years' old illustrating very repetitive, deeply-rooted personality tendencies toward narcissism.
Post script

It was a meeting of two doctors from two different worlds. As the action researcher I could not maintain a veneer of objectivity. I was reminded of what Lowman (2002, p. 324) said, “all organizational assessment is necessarily subjective.” My position was somewhere in between objectivity and subjectivity. I am a believer in intersubjective reliability. I was deeply moved and impacted by Dr Vangella's personality disorder. Dr Vangella is formidable. In my estimation, there was no way to try on a diagnosis and a possible intervention without Dr Vangella's buy in. Eventually, this was achieved in large part by means of establish a trusting therapeutic relationship. I alternated between psychotherapist and a high impact coach and consultant who was rapid cycling an assessment and intervention with a dysfunctional leader. The counseling and consultation was collaboration with the client. It was the result of an open book dialogue. I got in the loop with her internist and continued with “sessions” that were part executive coaching and part psychotherapy. Following the diagnosis, her internist created a new “cocktail” of medications that more directly addressed the personality disorder. Eventually, Dr Vangella came around herself and stated that she would accept the label of “narcissistic personality disorder” and “silently wear it as a symbol of why she got involved in Surrealist art.” She went on to state that “Salvadore Dali, Andre Breton and Antonin Artaud would all be proud of my royal pathology.” If I was interpreting her words accurately it appeared as if Dr Vangella was getting a bit narcissistic about her narcissistic personal disorder. That was a first.

No consultations with other employees were needed. The subtleties of this case necessitated that a systems level assessment and intervention not be approached. Dr Vangella was protected by the Americans with Disabilities Act, although I wonder whether the act encompasses “Surrealist Parisian Artists with Disabilities.” Dr Vangella opted not to be identified in the workplace and her personality disorder qualified as privileged doctor-patient communication. After four months of consultations and therapy combined with a successful program of medication, Dr Vangella began to tone down her arrogance and self-indulgent behavior to the point where she became sufficiently affable and mildly tolerable in the workplace. She deescalated to a merely toxic state. Consultations were continued, one to two times per week, for a period of 11 months.

Dr Vangella became a bit more self-mocking, playful and humorous about her narcissistic passions. She even made a few friends. No colleagues or staff filed formal complaints against her. Following several successful communication sessions between Dr Vangella and concerned colleagues, the informal grievances were all withdrawn. There were no further reports of failed mitral valve surgeries for the past three years. I wondered whether the undetected narcissistic personality disorder had in fact been the dysfunctional force resulting in the failed surgeries. I never said that. Luckily, no malpractice suits have been filed to date against the hospital or Dr Vangella. But the statute of limitations is still running.
Case study II: antisocial personality disordered leadership

Rick Boulder is the senior manager of WinnerWear International (WWI), a sportswear company primarily involved in innovating, designing and marketing WinnerWear (WW) basketball and athletic shoes.

Boulder is an unlikely senior manager, having worked his way up the corporate ladder without the benefit of a college education or an MBA. In fact, Mr Boulder dropped out of high school in the eleventh grade and returned in his mid-20s to finally ascertain his GED. Boulder started out his working career as a factory line worker for a world famous sports shoe and athletic wear Fortune 100 corporation, Berkeley Sports International (BSI). After three years on the factory line, Boulder was promoted to foreman, and he eventually got promoted to middle and senior management appointments. Boulder not only knew the sports wear and athletic shoe business from the ground up, but he also had street smarts and people skills that he learned on the sidewalks of Newark, New Jersey. Rick Boulder understood the mind of the blue-collar worker, was an alumnus of the mean streets and gang life, and ultimately graduated to upper management due to his ability to combine a big heart with a passion for quality and getting the job done. Boulder could explain total quality management, just-in-time (JIT), and zero defects in the language of the street. Boulder spoke directly to factory workers. He was definitively one of them.

Boulder was always known as a motorcycle riding, long haired, fiercely independent “s**t kicker” who “sliced his way to the gut of the matter in seconds.” Boulder was a charmer and confidence man. He was a master conversationalist and initially could be quite seductive. Initially, Boulder was much admired in BSI, but he also had a reputation as a “rebel without a cause.” Some of the line workers used to refer to him as a “Jersey version of early Marlon Brando on a bad night.” Boulder earned this reputation by showing a massive temper at times in the workplace when on different occasions he bullied and threatened “lazy” line workers, threw a company cat in a worker's face, and heaved a $2,000 computer through a factory plate glass window – in response to what he identified as “massive screw-ups, assholes and insubordination.”

On a more personal note, Boulder was three times divorced. His second wife committed suicide shortly after a messy divorce. Boulder has three children by his ex wives (one per marriage), and prior to his success in manufacturing he was in constant trouble with the law for failure to make child support and spousal payments. Boulder also has a history of clashes with authority. He was arrested on three separate occasions for physical altercations with a police officer and he has amassed a record-breaking number of traffic tickets for a two-year period in the State of Colorado. Since his last divorce, five years ago, Boulder, in his own words, “settled into the single life” and is constantly “searching for very young ladies who like to go biking on my BMW Café Racer … across the Colorado line and into the wilds of New Mexico.”
Initial assessment/diagnosis

Boulder wanted everything on the factory lines “to work like a charm” but in the workers' eyes, he contradicted himself. Rick demanded compliance with the rules to the ends of the earth. But when it was about Boulder, himself, he broke the rules all the time. He got sued for non-compliance with the Americans with Disabilities Act when he openly cussed out a physically handicapped line worker in language that cannot be repeated. Boulder got so angry one morning when line worker Paul Ruff was an hour late, that he waited for him in the parking lot and physically threatened him. There was a memorable altercation in the parking lot. Employees were watching through the windows. There was yelling accompanied by some pushing and shoving. Boulder and Ruff had to be restrained. Ruff vowed “never to forget.” Ruff resigned and litigation is pending.

According to factory workers, Boulder's leadership style was paradoxically both admired and perceived to be reprehensible. Many of the workers truly appreciated the in-your-face qualities of Rick's brand of leadership. If he did not like your work product or thought you were doing a lousy job, he would let you know in three tenths of a second. If he saw you “screwing up” at your station, he was very likely to walk right over, grab your arms and manhandle you into the “correct” behavior at the factory line. It did not matter if you were a male or female line worker. He would get irritable, aggressive and physical with workers. Boulder was not beyond physically assaulting his employees if he did not approve of what they were doing. Boulder was quite impulsive and shot from the hip. On one occasion, Boulder shoved a crane into the back of a shocked line worker and pretended that it was an accident. Jasper Johns was in shock. Johns told the personnel department that Boulder “had no respect for the workers' safety and is a monkey and baboon primitive.” Mr Johns required medical treatment and also proceeded to visit the infamous “sixth floor” for a series of sessions with the employee assistance counselors. This consequently led to the filing of a formal grievance and complaint against Boulder.

In what appeared to be directly related to Boulder's disruptive behavior, there was an increase in personal aggression (e.g. see Robinson and Bennett, 1995). Verbal abuse, loud altercations and physical confrontations became commonplace in the factory. Shouting and explosive anger fits became more prevalent. There were incidents of physical violence in the bathroom and the parking lot. Some workers were caught smoking marijuana during breaks. And there was growing talk among some of the younger, macho male line workers about “teaching Boulder a lesson that he'll never forget.” One worker warned that he was going to teach Boulder “the mother of all lessons.” Boulder heard about it. He got even meaner and more secretive, tougher and increasingly vindictive. If you crossed Boulder, watch out.

Boulder's physically and emotionally abusive behavior summoned increasing acts of revenge and retaliation from his targets. Subordinates were intent on getting “an eye for an eye.” The workplace became a battlefield. It was a physical and organizational battlefield that mirrored the land mines occupying Boulder's mind.

Boulder drove his workers hard. They were very productive and motivated up until the point when his strange, abusive and dysfunctional behavior was exposed to the light of day. At first, workers were scared and did not have a rule book for Boulder's anger and aggression. Personnel was always hearing about Boulder. The local police department had booked him numerous times on workplace disturbances. Everyone assumed something was wrong with Boulder. To say he had an “anger management” problem was to put it very lightly. The disturbed leader's venom had proved toxic and infiltrated the organizational system.
Consultation/psychotherapy with Rick Boulder

Boulder contacted my offices and said he wanted to make an appointment to see a psychotherapist. Boulder was paying out of pocket. He did not want his company to know. He did not want to bill it to his insurance company. He wanted anonymity and privileged communication.

I conducted a series of comprehensive case history interviews with Mr Boulder and administered several assessment instruments including the Global Assessment of Functioning (GAF) Scale (American Psychiatric Association, 2000, p. 34) and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Despite a long track record of dishonest, unethical behavior, Boulder made an attempt to be honest with me. Yet Boulder was without repentance. Boulder was extremely proud of his misbehavior. In his mind Boulder was a brutal angel “chosen to right some of the wrongs of this disgusting, lazy world of bums called factory line workers.” Boulder was quick to the draw, confident and even cocky. He boldly informed me on our first meeting:

Doctor, I want you to know in no uncertain terms, that I ain't no sociopath, psychopath or fruitcake! Don't you dare tell me no different!

In a serious of interviews consistent with a multiaxial, DSM assessment, I discovered that Boulder did in fact receive an initial diagnosis from his employee assistance program's counselor. The diagnosis can be interpreted in terms of what Ashforth (1994, p. 755) identified as a “petty tyrant” or “abusive supervisor” According to what Boulder shared of his experience with the EAP counselor, he was told that he “belittled subordinates, lacked consideration, showed extreme inflexibility and rigidity, ridiculed and physically abused employees, discouraged initiative from his workers, was perceived as arbitrary, unfair, played favorites, and used a forcing style of management.” Boulder was referred by the EAP to “anger management” counseling and training and this was conducted over a period of ten weeks. Boulder was repeatedly told that he “had to chill out” and “learn to control his emotions.” He was further instructed that “sometimes leaders get disgruntled and angry but with proper training and assistance they can get over it.” Concerning the repeated incidents of his physical abuse against subordinates in the workplace, it was described to Boulder (by his EAP counselor) as his “lack of emotional intelligence” and his “inability to keep the toxic workplace out of his mind.” In essence, Boulder was instructed that he was “suffering from a temporary lapse of civility and ability to maintain in public and that he would soon recover from his fight with anger, aggression and hostility.”

After carefully assessing the mental and emotional health track record established on Boulder within his company, I proceeded with a DSM-guided differential diagnosis. Synthesizing the results of the GAF Scale and the MMPI-2 with other assessment tools, I found that Rick Boulder had considerably more than an anger management problem. Boulder was suffering from a long-standing personality disorder that was significantly impacting his performance as a leader in the workplace. Boulder's diagnosis was antisocial personality disorder (DSM IV-TR 301.7). Boulder was the son of an abusive, cocaine-addicted, alcoholic father who also had been diagnosed and treated for antisocial personality disorder. Boulder's personality as revealed in the testing and clinical interviews was that of someone who is inflexible, maladaptive, and is an ongoing danger to self (DTS) and danger to others (DTO). Boulder's criminal behavior dated back to his pre-teen years and he had a long-standing pattern of: failure to conform to social norms with respect to lawful behaviors; deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure; irritability and aggressiveness, as indicated by repeated physical fights or assaults; reckless disregard for safety of self or others; consistent irresponsibility; and lack of remorse to injuries caused on others (see American Psychiatric Association, 2000, pp. 701-6).
Post script

Boulder was not happy when I informed him that his confidentiality and privileged communication status was threatened by my assessment that he was a DTS and a DTO in the workplace. After spending three weeks and nine sessions (cognitive-behavioral, rational emotive therapy) going round and round on the psychotherapeutic responsibilities related to DTS and DTO, we only started to understand each other. Once he knew that we were playing hardball, Boulder's behavior in therapy mirrored some of his destructive actions in the workplace, including turning on the charm, illustrating extraordinary powers of intuition and rational intellect, and periods of exhilaration and confidence followed by deep, dark depressive moods. Boulder had sophisticated techniques for trying to undermine and overturn the therapist. When his charm and interpersonal techniques did not produce results, Boulder attempted to find protection under the Americans with Disability Act, Title I (specifically targeting psychological disorders). Boulder verbally threatened me when he stated that if I “even thought about reporting any of this to anybody that he had harsh solutions in mind.” Once Boulder fully comprehended that I was not about to back off he decided that he would “cut a deal with me.”

As an action researcher, I increasingly understood what it was like to be with Boulder in the workplace. I was a participant observer to his personality disorder and Boulder quickly and methodically attempted to coerce therapist, colleagues, subordinates and the entire workplace into his web of pathology. His force, confidence and magnetism were in my face and the threats were real. Since he already felt that his life as a senior manager at WWI “truly sucked,” he decided to negotiate with me. Boulder was extremely concerned about not breaking any of this news to his CEO, Markus Duffy. Boulder finally acknowledged, after much redundancy in counseling sessions, that he was in the DTS and DTO category and due to this factor he was not fully protected by the Americans with Disability Act. Boulder recognized that it would be a struggle in futility to try to turn this around by naming himself as plaintiff and his company as the defendant in a lawsuit. It would more than likely be a losing battle. Boulder even went to the trouble of researching case law and precedent. He eventually decided that he did not want to take any legal action because it would call attention to his personality disorder. Boulder handed in his formal resignation. Boulder's resignation was accepted. I will not go into the legal proceedings that followed as this is privileged.

In subsequent follow up to Rick Boulder's departure, I was engaged in company-wide consultation with WWI. In this systems phase, I conducted a post-Rick Boulder organizational needs assessment, accessed date: re: productivity and profits, engaged in extensive observation of the workplace and conducted a series of open-ended narrative interview sessions with former colleagues and subordinates of Boulder. Overall, I noted two trends. The first was the widespread mimicking and mirroring of aspects of Rick Boulder's antisocial personality disorder throughout parts of the organization. Boulder's behavior appeared to have permeated some aspects of the system. The second trend was an organizational period of grief over the loss of Rick Boulder. Despite abuses suffered, organizational systems are infamous for defending and perpetuating their pathologies, maintaining and sustaining a dysfunctional equilibrium and resisting change and interventions. Over a period of two years following Rick's departure, the design division went through three leaders before deciding on the fourth leader as the one who was a cultural fit. This was part of the recovery process as the members of the organizational system were responding to losing their familiar source of conflict, the highly toxic senior manager, Mr Rick Boulder.
Discussion and limitations

The case studies presented are intended to provide management scholars with a “strategic sampling” of personality disorders in leadership within organizational contexts. Utilizing the DSM IV-TR as a central hub for assessment of pathology, the seriousness of the organizational conflicts and leadership disturbances presented required diagnoses and interventions typically falling outside the expertise of management professionals. I label the case studies as a strategic sampling due to the fact that the leaders described exhibited highly defined characteristics of pathology. In the diagnoses of narcissistic personality disorder and antisocial personality disorder, the leaders in question presented more than the minimal number of symptoms to merit the labels allotted them. In choosing two cases to convey, I carefully searched for cases epitomizing more extreme, well-defined characteristics of personality disorders. My action research and case study agenda has been to “utilize extreme cases to develop rich theory” (Elsbach, 2005, p. 10).

The two cases describe “pre-existing” personality disorders traceable via “911” reports of organizational crises. The organizational red flags pointed back toward leadership as “personality disorders are inevitably manifested in social situations” (Vaillant and Perry, 1980). This in turn led to the singling out of leaders for individual case histories and assessment. In the two case studies the DSM-guided diagnoses of personality disorders were determined not to be a direct or primary outgrowth or product of a dysfunctional, pathological organizational system – hence the “pre-existing” determination. This does not discount, however, myriad mediating and interacting systems generated stressors, workplace conflicts and organizational variables adversely impacting the troubled leaders and accelerating their symptoms. Moreover, another researcher may have assessed these same cases as exhibiting a nexus of pathology in the organizational culture via a more macro systems dynamics approach (e.g. see Senge, 1990).

A major concern and limitation in framing an individual differences approach based on the DSM is the need to integrate this seemingly old school traits influenced perspective within a more holistic, systems analysis. From a process or systems view (e.g. see Argyris, 1985; Checkland, 1981; Gallessich, 1983; Schein, 1969, 1987; Senge, 1990) there are limitations to a primary focus on the individual rather than centering the inquiry on the pathological behaviors and patterns in the larger system itself. Despite my initial holistic scanning of each organization, extensive periods of observation within each workplace, and the compiling of multi-faceted and systemic needs assessments, I settled down to an incremental, more modest focus on specific individuals. Is this not a reductionist methodology supplying only a mere snapshot within a vast pool of systems pathology? Moreover, how do we explain symptoms in the individual leader interacting with a change in environment and resulting in pathological behavior? In other words, is it not a serious limitation to be focusing upon a nexus of leadership pathology when the organizational system, itself, is in part responsible for the leader's behavior?

Philosophically, it is impossible to antiseptically extract any individual differences from systems influences; any individual differences assessment would necessarily incorporate systems variables. This is a given. The more important concern is one of degree and professional judgment. In the cases presented the organizational system stressors were in my clinical opinion not sufficient to warrant my initial and primary response to the broader systems pathology. It was my judgment that despite the fact that the two organizations did in fact incite, provoke and activate dimensions of each leader's pathology and exhibit some systems wide dysfunctional patterns, the most immediate 911 fires to be attended to were in leadership. Keep in mind that as a practitioner engaged in action research I have somewhat different constituencies to answer to than does the researcher who functions solely within an academic context. Although the act of writing this paper speaks to my academic community of stakeholders comprised of researchers and scholars, I am also committed to the primary sponsor or client who expects ROI, and rapid cycle, accountable outcomes. I do concede, however, that there are of course some limitations to my clinical judgment as it may well be that some researchers will feel compelled to take issue with my determinations. Once again, this entails the limitations inherit in usage of the DSM and the orientation of the individual clinician. Presuppositions and subjectivity are always in play. Judgment calls cannot be sidestepped or diluted.

Viewed from the necessarily pragmatic viewpoint of the practicing consultant and corporate client, are there many CEOs out there who want to be told that “I diagnosed your organization and I am sorry to inform you that the entire system suffers from narcissistic personality disorder or borderline personality disorder?” In essence, this systems perspective is a theoretical analysis that may incorporate some seeds of truth. But in Corporate USA it is far more affordable and plausible to avoid the “Trojan horse syndrome” characterized by myriad traditional consultants who descend on the company, analyze the system from A to Z, deliver an impressive, costly, bulky report and exit prior to implementation (see Schaffer, 2002). In contrast, I provide a high impact consultation approach (see Schaffer, 2002) utilizing DSM IV-TR assessment tools en route to identifying the most urgent subprojects within the organizational system. This approach entails a rapid cycle, brief therapy, action agenda of organizational change via a seriously needed assessment of an antisocial or narcissistic personality disorder in a deeply disturbed leader. This seemingly individual differences approach based on the DSM does not negate, whatsoever, a fifth discipline systems dynamics (Senge, 1990), companywide OD, or general systems influenced orientations. It rather positions the incremental participatory action research study and consultation within a broader systems campaign tempered to ROI, cost containment and the complex realities of a vast organization. Ultimately the real challenge is one of integrating individual differences and systems models. Providing treatment for a leader with narcissistic personality disorder, for example, does not negate a broader “organization on the couch” pattern of systemic narcissism worthy of further assessment and intervention.

Occasionally I have found that divisions or entire organizations appear to inspire a DSM-based personality disorder diagnosis. In the case of Rick Boulder's departure from his company the entire system displayed clear symptoms of an antisocial personality disorder. It was a pathway from “leader on the couch” to “organization on the couch.” But this systems application of the DSM presents myriad variables and challenges. Can we move from an individual differences approach to an organizational systems adaptation of the DSM? The clinical application of the DSM to organizational assessments presents a golden opportunity to truly put the “organization on the couch.” Surely, Kets de Vries has been knocking on this door and stimulating research and debate for decades. Hopefully, my analysis may persuade some to take another step in crossing disciplinary lines by investigating criteria for high toxicity or psychopathologies and applying the DSM IV-TR (and the subsequent DSM V) to systems analysis.

There are limitations to this study that point toward the DMS IV-TR, itself, and how it is operationalized. The DSM IV-TR is obviously not a manual to be pulled off the shelf by the average leadership researcher or management consultant as it requires deep clinical training. However, I contend that trained or not, it is important to acknowledge the promise that it holds for leadership and OD research and applications. But there are significant limitations surrounding the logistics of incorporating the DSM into the leadership and management repertoire. Few leadership researchers or management consultants are significantly trained or credentialed in the DSM. Accordingly, the case studies presented in this paper may fall outside of their interest or expertise areas. It is not without merit, however, to consider the implications of studying DSM diagnosed leadership pathologies inasmuch as this may be an asset in working with leaders who have narcissistic tendencies but fall short of meeting the criteria for a personality disorder.

The DSM IV-TR presents a disciplinary challenge. How do we overcome disciplinary limitations, move beyond the realm of “milder” or “lighter” toxicity investigations and incorporate the prospect of the study of psychopathology into our research and consultations? While a few leadership scholars have credentials in both management and psychotherapy allowing for reference to and usage of the DSM (e.g. see Goldman, 2005; Lubit, 2004), another promising route is through cross-disciplinary collaborations as recommended by Lowman (2002). Interestingly, it is not just a case of organizational researchers who lack DSM expertise in their investigation of leadership, as our counseling and industrial psychology neighbors conversely need systems and management expertise and are ripe for collaborations (Lowman, 2002).

Another limitation to this study surrounds the fact that the credentialed use of the DSM does not eliminate the existence of discretionary, subjective elements throughout the assessment, intervention and implementation process. The DSM IV-TR is only as good as the clinician and is not a cook book or set of rules to be applied uniformly. Moreover, there is ongoing debate in the psychological and psychiatric communities over the viability of some of the DSM criteria and theoretical justification for diagnoses (e.g. see Livesley, 2001). Objective, standardized psychological testing is inadequate as a sole means of data collection (e.g. the MMPI-2) and does not replace clinical judgment and a differential diagnosis. Assessments covering the criteria content for a DSM assessment typically include both testing and the positioning of the expert as a diagnostician and participant action researcher. Researchers considering the incorporation of the DSM into their organizational research and consultation should also note that there are personality assessment tools available such as the MMPI-2 and the Global Assessment Functioning Scale (see American Psychiatric Association, 2000, p. 34) also known as the “GAF”, and myriad other instruments derivative of various schools of personality research (e.g. the “five-factor model” and the Big Five Theory of personality traits).

A further limitation includes the issue of the generalizability of an action research agenda. I recognize that the soft qualitative data and anecdotal reports generated are not likely to be easily replicated in other settings by other researchers. As an action researcher, however, I am most concerned with generating prospects for rich theory, stimulating strategic dialogue and questioning, serving as a change agent, and challenging current limitations of precedent research. In selecting more extreme cases of pathology I am examining the farther reaches of leadership dysfunction. Are these representative case studies of dysfunctional leadership? Are they with merit for the study of the “dark side” of leadership and organizational systems? Leadership researchers and management consultants may only encounter leaders with less well defined characteristics than those highlighted in this paper. Will researchers lacking DSM training confuse narcissistic behaviors and tendencies with a narcissistic personality disorder? Accordingly, I am concerned that there is the clear and present danger of an uncritical adoption of the DSM IV-TR, whereby leaders with “normal pathology” and intermittent toxic behavior in the workplace are mistakenly assigned a clinical diagnosis of pathology. Once we consider the possibility of assessing psychopathology in leaders, workers or organizational systems we are entertaining the dangers of misdiagnosis. For example, uncritical usage of the DSM may result in the over-diagnosis of a depressive personality disorder for a leader who is temporarily responding to organizational stressors. Or another DSM failure may be reflected in the inability to grasp the seriousness or gravity of a pathology and its consequences for an organizational system. In the case of Rick Boulder, the EAP initially diagnosed him as a “petty tyrant” and an “abusive supervisor.” While both are fitting, this was an under-diagnosis of a far more serious antisocial personality disorder. Boulder's sociopathic and psychopathic personality traits had been unwittingly trivialized and designated as a more commonplace, normal disturbance and source of conflict in his workplace. Sadly, this missed diagnosis resulted in extremely negative consequences for Boulder's organization.
Conclusion

A common response heard at the Academy of Management is that “we are not in the business of healing sick leaders and pathological companies; we are not psychiatrists.” In response, I find that the specific sub specialty of personality disorders in leadership as it relates to organizational systems has been on our agenda for quite some time. Surely, if there was any doubt, that was addressed back in 1984 when Kets de Vries and Miller presented us with The Neurotic Organization, and Kets de Vries followed with Organizations on the Couch in 1991. It was now officially out in the mainstream that the management discipline had moved from decades of big five, trait, and individual differences approaches to personality research into the more rarefied and extreme arena of assessing sick leaders and companies. A golden bridge was under construction linking leadership, management and psychology under the shared umbrella of toxic individuals and systems. On closer examination I found that this bridge was partial and conditional. It appeared as if the issues of psychopathology or mental and emotional toxicity in leadership were frequently alluded to in the leadership literature but the crux of the research agenda was with leaders who fell short of a DSM diagnosis. In fact, in an interview with Kets de Vries, published in 2004, he stated that “people in mental hospitals are easy to understand because they suffer from extreme conditions. The mental health of senior executives is much more subtle” (Coutu, 2004, p. 66). As illustrated in this paper, I have encountered leaders who suffered from mental illness but were able to maintain their leadership roles and be productive up until the point where their personality disorders became detrimental and prohibitive. Once diagnosed, the majority of leaders I have worked with have only received out-patient care and rarely reached a point where they needed to be an in-patient in a mental health facility. Moreover, it is well documented that narcissists can be quite productive as leaders in the workplace (Kets de Vries and Miller, 1984; Maccoby, 2003). Future research may in fact pursue whether leaders suffering from narcissistic personality disorder, for example, do in fact bring added value to their organizations.

Troublesome is the growing incidence in pop leadership publications of pseudo-diagnoses and references to personality disorders, but without meeting the DSM criteria for same. As social scientists we are more than capable of describing and interpreting narcissistic behaviors. But once we get into the business of talking about narcissistic and borderline executives or we describe entire companies as narcissistic, then we are making sweeping personality assessments and potentially stigmatizing individuals with an unwarranted, flippant, unofficial personality disorder diagnosis. Without a working knowledge and application of the DSM we are constantly confusing and blurring the lines between “narcissistic behaviors” or “narcissistic traits” and “abnormal narcissistic personality disorders.” Considering the possible consequences of our words for leaders and organizations, I find there is little margin for error. Any error is egregious. Are we merely borrowing, shaping and molding the DSM IV-TR in order to extend our management arsenal into the exotic and topical arena of toxicity? Are we not concerned with the precision of DSM language and diagnoses designed by our neighbors over in counseling and industrial psychology and psychiatry?

Since it only takes one sick leader to bring down an organization are we satisfied with a repertoire of leadership assessment tools that fall short of recognizing the prevalence and inevitability of narcissistic personality disorder among our leaders? Trivializing pathologies and perceiving them as normal disturbances in the workplace is potentially quite detrimental in a volatile workplace already embroiled in bullying, toxic behaviors, aggression, violence, and what has recently been identified as organizational terrorism (Van Fleet and Van Fleet, in press). Surely, undiagnosed or misdiagnosed pathologies in our leaders are a precursor to ever escalating organizational dysfunction. Just one failure to timely assess may yield dramatic interpersonal and systemic repercussions including sabotage, plunging motivation and productivity, increased turnover, and a high incidence of internal grievances, formal complaints and litigation.

I fear that we may at times be fearful, ourselves, of the unknown. Are we keeping the doors locked on those mysterious psychological disciplines down the road? Perhaps we at times mirror our clients' behavior when we lack readiness and are resistant to assessments, interventions and disciplinary change. But by virtue of our excursion into unhealthy organizations and leadership it was inevitable that we would follow the trail into full-blown pathology. The DSM is rapidly within reach by virtue of cross-disciplinary collaborations. Surrounding DSM issues addressed in this paper, I envision an increasing dialogue between the management and psychology communities. In some instances, there may even be a drive to extend our individual management specializations into the field of psychology resulting in more DSM expertise and psychology credentialing in business schools and management consulting groups.

Future investigations may continue to pursue action research and case studies as presented in this paper, or choose to move in more empirical and quantitative directions. Along these lines, much needs to be done to bridge “individual differences” and “systems approaches” to leadership pathology and organizational dysfunction. A lofty challenge faces us in attempting to integrate the DSM IV-TR into leadership, OD and consulting perspectives within the management disciplines. An even loftier challenge centers about the potential viability of the DSM in companywide, systemic analysis of pathology (e.g. see Minuchin (1974) for a “family systems” approach). Innovative hybrids of the DSM, fifth discipline systems dynamics, OD, and reinventions of old general systems theory may prove interesting and fruitful.
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Senge, P. (1990), The Fifth Discipline: The Art and Practice of the Learning Organization, Doubleday, New York, NY, .

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Spector, P., Fox, S. (2005), Counterproductive Work Behavior: Investigations of Actors and Targets, American Psychological Association, Washington, DC, .

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Strasser, F., Strasser, A. (1997), Existential Time Limited Therapy: The Wheel of Existence, John Wiley & Sons, London, .

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Vaillant, G., Perry, J. (1980), "Personality disorders", in Kaplan, H., Freedman, A., Sadock, B. (Eds),Comprehensive Textbook of Psychiatry III, Williams & Wilkins, Baltimore, MD, .

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Van Fleet, D., Van Fleet, E. (in press), "Internal terrorists: the terrorists inside organizations", Journal of Managerial Psychology, No.special issue: dysfunctional leaders and organizations, .

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Further Reading

American Psychological Association (1993), "Guidelines for providers of psychological services to ethnic, linguistic, and culturally diverse populations", American Psychologist, Vol. 48 pp.45-8.

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Ashforth, B. (1994), "Petty tyranny in organizations: a preliminary examination of anecdotes and consequences", Canadian Journal of Administrative Science, Vol. 14 pp.126-40.

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Baltes, B., Staudinger, U., Lindenberger, U. (1999), "Lifespan psychology: theory and application to intellectual functioning", Annual Review of Psychology, Vol. 50 pp.471-507.

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Bergan, J. (1977), Behavioral Consultation, Merrill, Columbus, OH, .

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Blanton, J. (2000), "Why consultants don't apply psychological research", Consulting Psychology Journal: Practice and Research, Vol. 52 pp.235-47.

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Bradford, L., Gibb, J., Benne, K. (1964), T-group Theory and Laboratory Method, Wiley, New York, NY, .

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Cartwright, D., Zander, A. (1968), Group Dynamics Research and Theory, Harper-Collins, New York, NY, .

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Czander, W. (1993), The Psychodynamics of Work and Organizations: Theory and Applications, Guilford Press, New York, NY, .

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Ellis, A. (1993), "Reflections on rational-emotive therapy", Journal of Consulting and Clinical Psychology, Vol. 61 No.2, pp.199-201.

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Hall, D., Otazo, K., Hollenbeck, G. (1999), "Behind closed doors: what really happens to executive coaching", Organizational Dynamics, Vol. 27 No.Winter, pp.39-53.

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Hallowell, E.M., Ratey, J.J. (1994), Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood through Adulthood, Touchstone, New York, NY, .

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Hartmann, T., Bowman, J., Burgess, S. (1996), Think Fast: The ADD Experience, Underwood, Grass Valley, CA, .

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Hogan, R., Curphy, G., Hogan, J. (1994), "What we know about leadership: effectiveness and personality", The American Psychologist, Vol. 49 No.6, pp.493-504.

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Kelly, K., Ramundo, P. (1993), You Mean I'm Not Lazy, Stupid or Crazy: A Self-help Book for Adults with Attention Deficit Disorder, Scribner, New York, NY, .

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Kepner, C., Tregoe, B. (1997), The New Rational Manager: An Updated Edition for a New World, Kepner-Tregoe, New York, NY, .

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Kernberg, O. (1978), "Leadership and organizational functioning: organizational regression", International Journal of Group Psychotherapy, Vol. 28 No.1, pp.3-25.

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Kernberg, O. (1979), "Regression in organizational leadership", Psychiatry, Vol. 42 No.1, pp.24-39.

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Kernberg, O. (1998), Ideology, Conflict and Leadership in Groups and Organizations, Yale University Press, New Haven, CT, .

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Kets de Vries, M. (1985), "Narcissism and leadership: an object relations perspective", Human Relations, Vol. 38 pp.583-601.

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Kets de Vries, M. (1993), Leaders, Fools and Imposters: Essays on the Psychology of Leadership, Jossey-Bass, San Francisco, CA, .

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Kets de Vries, M. (2001), The Leadership Mystique: An Owner's Manual, Pearson, London, .

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Kilburg, R. (2002), "Individual interventions in consulting psychology", in Lowman, R. (Eds),Handbook of Organizational Consulting Psychology, Jossey-Bass, San Francisco, CA, .

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Kotter, J. (1990), A Force for Change: How Leadership Differs from Management, Free Press, New York, NY, .

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Lawler, E., Nadler, D., Cammann, C. (1980), Organizational Assessment: Perspectives on the Measurement of Organizational Behavior and the Quality of Work Life, Wiley, New York, NY, .

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Lipman-Blumen, J. (2001), "Why do we tolerate bad leaders: magnificent uncertitude, anxiety, and meaning", in Bennis, W., Spreitzer, G., Cummings, T. (Eds),The Future of Leadership: Today's Top Leadership Thinkers Speak to Tomorrow's Leaders, Jossey-Bass, San Francisco, CA, pp.125-38.

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Von Bertalanffy, L. (1950), "An outline of General Systems Theory", British Journal of Philosophical Science, Vol. I pp.134-63.

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Von Bertalanffy, L. (1968), General Systems Theory: Foundations, Development, Applications, Brazillier, New York, NY, .

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Corresponding author

Alan Goldman can be contacted at: [email protected]
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